HomeMy WebLinkAbout0035 BURSLEY PATH - Health 35 Bu sl.ey Path -
West Barnstable
A = 089-006
4
i
c
o
r„ ,
TOWN OF BARNSTABLE
LOCATION SEWAGE# -Z020 • (4g
VILLAGE J J. GG r TN- ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO. B g- 9) Ew,2-uo-A�or
SEPTIC TANK CAPACITY /S00 4a 1
LEACHING FACILITY:(type) SOD I Ll C 4�2� (size) 03 X 2,6 x 2-
NO.OF BEDROOMS
OWNER iUEE L Y L y 0n5
PERMIT DATE: 2. 12- Z 0 COMPLIANCE DATE: 2. 14' Z O
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
3r I4
A2^ 28 `
O2• Go G
6,cAR 3
,63
. '71 'G''
A+ 63'$
3
O Pool
Fl �, TOWN OF BARNSTABLE
�3�-, q
LOCATION 40T/ a-pS SEWAGE #
VILLAGE eA1S g,44 JF- ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO. 6 o
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) ('I aLD U la S E(CS (size)
NO. OF BEDROOMS PRIVATE WELL
/OR PUBLIC WATER
BUILDER OR OWNER m ij R k � �h
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: rA I �� C1G
VARIANCE GRANTED: Yes No /
l _
y 3
J
.0
D
�
ASSESSORS MAp N%_C�_ f
ee
THE COMMONWEALTH OF MASSACHUS
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Application for Mitpool *p6tem Con6truction i9ermit
Application is hereby made for a Permit to Construct>Q or Repair( )an On-site Sewage Disposal System at:
Location Address or Lot No. Owner's Name,Address and Tel.No.
LCjr
Installer's N e,Add s,and Tel.No. Designer's Name,Address and Tel.No. l�� d�/�SSC /itlC�
k1el � c Q� ,� Ozc.-a5 p• c 1 4 j AitMotP% t V+ { �
sm?_ 3
Type of Building:
Dwelling No.of Bedrooms 3 Garbage Grinder( )
Other Type of Building No. of Persons Showers(a) Cafeteria( I )
Other Fixtures
Design Flow 13;30 gallons per day. Calculated daily flow :33 gallons.
Plan Date i< < Si Number of sheets Revision Date
Title S-- r -
Description of Soil e
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construct' an aintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title t iron ntal Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by t s d
Signed Date
Application Approved by `
Application Disapproved for the following reasons
Permit No. 1,9 Date Issued �� �
- a = THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -:TOWN OF BARNSTABLfs MASSACHUSETTS
01pplication for Migpool *pgtem Congtruction Permit
Application is hereby made for a Permit to Construct(}Q or Repair( )an On-site Sewage Disposal System at:
Location Address or Lot No. Owner's Name,Address and Tel.No.
3 5 . ANs Lcsr
Installer's��m cddre s,and Tel.No. Designer's Name,Address and Tel.No.
Y t + e, r'(�t Ozc.�S r . O . o>< !! 9 �io+zw�ot �,� f- MA
�i
Type of Building:
Dwelling No.bf Bedrooms 3 Garbage Grinder( )
Other Type of Building No.of Persons Showers`(02) Cafeteria( / )
Other Fixtures
Design Flow 330 gallons per day. Calculated daily flow 33 gallons.
Plan Date Number of sheets Revision Date
Title S E — e WA
Description of Soil
4
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construct' an aintenance of the afore described on-site sewage disposal system
in accordance with the provisions of TiMto
viron ntal Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued byVdi�H
_ •
Signed Date l
Application Approved:by
t Application Disapproved for the following reasons
Permit No. _ 9 9 Date Issued / e'
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
r
THIS IS TO CERTIFY,that the On-site Sewage Disposal System
insstalled o repaired/repl d on
by 2f t es- ' OG • for "e l U/Qk_r Yko( _Z �
a , has been constructed in actor nee
with the provisions of Title 5 tnd the for Disposal System Construction Permit No. / dated 2 -
Use of this system is conditioned on compliance with the provisions set forth below:
o av
No. Fee /Lo_
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTAB.LE,_MASSACHUSETTS
Digogar 6P.5tem Congtruction Permit
Permission is hereby granted to wGto construct(>)repair( )an On-site Sewage System located at 3 tJ r S
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
All construction must be completed within two years of the date below.
Date: Approved by
No. �t✓ o 0 Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: a!
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
application for Mispo8AY 6pBtrin Construction 3permit
Application for a Permit to Construct( ) Repair(v/) Upgrade( ) Abandon( ) ❑Complete System [Individual Components
LocationAddress or Lot No. 35' BvrS 4.4 po^ Owner's Name,Address,and Tel.No.
W. 6acn5tobta,
Assessor's Map/Parcel Neill Lyons Si�etho.,•�
Installer's Name,Address,and Tel.No. t3 Q.xcavo io(s Designer's Name,Address,and Tel.No. (wlwr}� Sc.AU�CO.
3 N. Rook-e. 130 $p ndw�o►. 508• y 77 . Ob.S P.O. (&ox 331 44cw"c-h Ma,. 02 qS
Type of Building:.
Dwelling No.of Bedrooms 3 Lot Size 3,5. Qyy sq.ftt/• Garbage Grinder(140)
Other. Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 33Q gpd Design flow provided gq$ gpd
Plan Date 2,11 I to Number of sheets Z Revision Date
Title
Size of Septic Tank 1 SO 0 Type of S.A.S.(Z) 500 noa\lern OnaM64CS
Description of Soil SeX p►a,&
Nature of Repairs or Alterations(Answer when applicable) Re f to ce. Vw.1¢c15S 01 (23 Sdy oko-kn LC'S O+20)
-an& H•7,0 D63
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health. o
Si Date
Application Approved by a/ Date
Application Disapproved by Date
for the following reasons
Permit No.7_0z0ngpi Date Issued (Z OO
No. !r 0 2 0 Q Fee
' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: '
PUBLIC HEALTH DIVISION — TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ZippYiration for Disposal *pstem Construction i3ermit
Application for a Permit to Construct( ) Repair(A Upgrade( ) Abandon( ) ❑Complete System Individual Components
Location Address or Lot No. 3 5 (3 Owner's Name,Address,and Tel.No.
Assessor'sMap/Parcel 4A
)arr,;tch\e f\jell'I LkjonS
Installer's Name,Address,and Tel.No.,(�3 (� E x c c,v C A k v Designer's Name,Address,and Tel.No.
i
RoU}c Imo S�,ndw,ci• Svc �I11 t.S Q.O. fox 331 }4o,(w,t\-) ({)og, n ( w`
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size 347 n q vj sq.ft+/ Garbage Grinder(Mc))
Other Type of Building No.ofTersons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) ( l gpd Design flo providedy gpd
1
Plan Date Z.111 ?_O Number of'sheets Revision Date
Title -~-"
Size of Septic Tank I SO 0 _Type of S.A.S. 1 Uoor,11 r o c
Description of Soil_ 1�,P_e_
z�
Nature of Repairs or Alterations(Answer when applicable) R. p I —fir „-r cAc, ,r k r,n, o (H- 2 o
_ Date last inspected:
Agreement:
undersigned agrees to ensure the construction and maintenance ofthe-afore)described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Sign d Date
'Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No.7DZ Date Issued
---------------------------------------------------------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(�) Upgraded( )
Abandoned( )by
at `� {�,,r 1 a,, ��1 has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.20Z-0 pq 00 dated 2 112 J yn7Z)
Installer P) ; R F,r r«un4,n `n( . Designer cl¢r�., S n,, c r:rnon�r•\
#bedrooms Approved design flow A 7,7 L god
The issuance of this pe it sha 1 not be construed as a guarantee that the system will cti asJdesigned.
Date a v Inspector �/
-- ----------- ---- --------------- --_--------------------- --- ----------------- -------------------------- -- -----
0
- No. 7070 " 70 Feel �)/00 d
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Disposal 6pstem Const urtion permit
Permission is hereby granted to Construct( ) Repair( vl) Upgrade( ) Abandon( )
System located at y r e I r Q,l h
I
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this perm
Date �/7 7 n 7 Approved by permit
_
Town of Barnstable
Inspectional Services
BAWWAS
Public Health Division
59ASS Thomas McKean,Director
039.c tom° 200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304:
Installer& Designer Certification Form
Date: Z -19- ZO Sewage Permit# -Zo 20- q9 Assessor's Map\Parcel
Designer: ()-,,y_- lF akcrAc=4 Installer: Q+4_Q Exc L 'I ors
Address: c) !Bnx '331 Address: ly 'reg—Sct-r-y LwD
�Qct,a 1 CVO. �Oi"C3'�o�a.I G
On 2.12 20 S3� Ci Excsayo�-1io was issued a permit to install a
(date) (installer)
septic system at Burslcy -RIAV, based on a design drawn by
( dress)
�aL�c �lohcr�c dated Z-/1 - Z O
(designer)
X I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box'and/or septic tank. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State&Local.Regulations. Plan revision or
certified as-built by designer to follow: Strip out(if required)was inspected and the soils
were found satisfactory.
I certify that the system referenced above was constructed i .with the to rms of
the IAA approval letters(if applicable)
�JAiI�9`y
D.
FLAHERTC 1R,
No M.i
(I taller's Si a )l — ,
.. , S,yN;�aklpts
'-(Designer's Signatur (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC.HEALTH DIVISION.
THANK YOU.
WoAdeptAHEALTMSEWER conned\SEPTIC1Desiper.Certirication Form Rev 8-1413.DOC
Ld a
MAY,-16-96 THU 15 : 15 ENVIRQ.TECH LABS 508 888 6446 P. 01
ENVIR.OTECH LABORATORIES INC.
MA Cert. No.: M-MA 063
449 Rte. 130 ' Sandwich,MA 02563
(508)888-6460 . 1.800-339-6460
FAX(508)888-6446
CLIENT: Mark Sheehan LOCATION: Lot #1-. .
Bursiy Path
W. Barnst able..- MA
SAMPLE DATE: 4-30-96 n
COLLECTED ,BY: Aqua-Jet Wells DATE RECEIVED: 4--30-96 '
TIME: 10:OOAM LAB I.D. #: E4-395
JOB TYPE: New wel.1 SAMPLE I.D. #k: E4-30
WELL SPECS:: 130'
RESULTS OF ANALYSIS:
Parameters Units Recommended Limit Result
Coli.form bacteria/10W (MF Method) 0 0
PH PH units 6.0-8.5 7.17
Conductance umhos/cm 500 .129
sodium mg/L 28.0 12.3
Nitrate-N/Nitrite-N mg/L 10.0 0.24
Iron mg/L 0.3 02
Manganese mg/L 0.05 0.:006
volatile Organics See enclosed report.
EPA 524 ug/L
Chloroform 100 a26A .
t ,
Yes No WATER IS SUITABLE FOR DRINKING
XXX POSES F PARAMETERS TESTED.
Date 4 (
on ld J. S ri
Laboratory irector
LT = Less Than ;
MAY-16-96 THU 15 : 16 ENVIROTECH„ LABS 508 688 6446 P. 02
LAPUCK
LABORATORIES, IIYG
SO Hunt Street CHEMICAL ANALYSIS
Watertown,MA 02172 BACTERIOLOGY
(617)923-0300 WATER ANALYSIS
FOOD ANALYSIS
REPORT SP13dhdAVON TESTING
k a.
LAB NO. 55076 May 16, 1996
Mr. Ron Saari
ENVIROTECH LABORATORIES, INC, Sample Received: 04/25/96
449 Route 130 Client 1.D,: Aqua Jet
Sandwich, MA 02563 Sample 1.D,: Lot#1 -Suirsley
Teat.Results:
Volatile Orguks-ppb(ug/L)
Method#524
Benzene N.D. 1,2•Diehloropropane N.D.
Brornobervene N.D. 1,3-DichloroVopane RD,
Bromochlorometbane. N.D. 2,2-Dichloropropane N,U.
Bromodichloromethane N,D. 1,10chloropropene N.D.
Bromoform N.D. Cis-1,30chloropropme N.D.
Bromomethane N.D. Trans-1,3-Dichloropropene N.D.
N-Butyl Benzene N.D. Ethylbenzette N.D.
Sec-Butyl Benzene N.D. Hexachlorobutadiene N.D.
Teri-Butyl Benzene N.D, lsopropylbenzene N.D.
Carbon Tetrachloride N.D. P-Isopropyltoluene N.D.
Chlorobentene N.D. Methyl Chloride N,D,
Chloroethane RD, Naphthalene N,D,
Chloroform 2.6 N•Propylbenwe N.D.
Chloromethane N.U. Styrene N„X
2-Chlorotoluene N.D. 1,1,1,2-Totrachloroethane N.D.
4-Chlorotoluene N,D. 1,1,2,2-Tetrochloroethane N.D.
1,2-Uibromo-3-Chiloropropatte N.D, Tet ubloroethene N.D.
Dibromomethane N,D Toluene N.D,
1,2-Diehlorobeaene N.D, 1,2,3 Trichlorobenzene N,D.
0•Dichlorobenzetie N.D. 1,2,4•Trichlorobenzene N.D.
1,4-Dichlorobeozene N.D. 1,1,1-Trichloroethane N.D.
Dibromochloromethane N.D. 1,1,2-Trichloroetbane N.D.
1,2-Dibromoetltanee (EDB) N.D. TricltloroBtroromethane N.D,
DichloroMuoromethane N.D, Trtehloroethane N.D,
1,1-Dichlometime N.D. 1,2,3-Trichloropropane N.D,
1,2-Dichlor ethane(,EDC) N.D. 1,2,4-Trimethylbenzene N.D.
l,i-Dichloroethetene N.D. 0.5-Thmethylbenzene. N.D.
Cis.1,2-I ichloroethylene N.D. Vinyl Chloride N.U.
'Di n •D otat e
N.D. N.D.
Not Detected Analysis Date ,05/07/96
Method Delection Limit 0.5 ug/L
ri 8 f a urroAa -
1,2-Dichlorobenme-d4 80
P-Bromofluorobenzene gp
• E.P. 061 -----�
Consulting_& Testing Services �.........,._.-__ . _L AI.__...
Fee - - - -
BOARD OF HEALTH
TOWN OF BARNSTABLE
Zpp[ication Ar Vell Congtruction jermit
pplicatio s hereby made for perm to Construct ( ), Alter ( ), or Repair ( )an individual Well at:
� � s -
p Loc Ion — ddress - --arcel — —
_Jly_JvY" Assessors Map and Parcel
Owner — —Add ———— — —
��y 2 ------- Address
— ��
------------------------------------ ---
Installer — Driller
Address
Type of Building
Dwelling--------------------------------------- ----------
Other - Type of Building------------------------------------ No. of Persons------------------------------------------------------
Typeof Well----------------------------------------------------------------- Capacity-------------------------------------------------------------------------
Purposeof Well---------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to
place the well in operation until a Certificate .of Compliance has been issued by the Board of Health.
Signed ` y ------------------------------------- ---------------------------------
date
Application Approved By--
�— ---- — -- W date
Application Disapproved for the following reasons:------------------------------------------------------------------------------------------------------
-----------------------------------------
---------------------------------------------
------------------------------------------------------
---------------------------
''.. •• date
Permit No. -`1���-� -— ----- -- Issued-------------------------------------------------------- ---------------------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
(Certificate ®f (Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( )
by------------4,CLeJA- ------ - - -- - --- - - -- --
^------- — — Installer
aA
at-------- — - -- - "`=has been installed in accordaMe with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No. ---------------------------Dated---------------_____-_--_
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------------------—-—-- - - - - -- Inspector----------------------------------------------------------------------------
__ >: -- - -
No. � ----a"? Fee
BOARD OF HEALTH
TOWN OF BARNSTABLE
Application-for lVell Conoructionperntit
Applicatio is hereby, made for a perm. to Construct ( ), Alter ( ), or Repair ( )an individual Well at: -
} -� --------- - - - -- - - - - - - -
sLoc ion — Address Assessors Map and Parcel
--------------------- ---------------------------------------------
Owner Address
-----------
Installer — Driller Address
Type of Building <
Dwelling---------------------------------------- ------------------------
Other - Type of Building --- No. of Persons----------------------------------------------------
Type of Well—----—- —- -— - - Capacity -— ------------------ = --- ----- f
Purpose of Well------------------------------- - - —
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of Thi,
Town of Barnstable Board of Health Private Well Protection Regulation The undersigned further agrees not'to
place the well in operation until
.-a/Certificate .of Compliance has been issued by the Board of Health.
Signed-- - / ----------------------------------------------------- ---------------------------------
.,
date
Application AP roved B —P < J � -- �
date
i«=• Application Disapproved for the following reasons:---------------------------—----------------------------------------—------------------
------------— -- ------- -----_-------- --------------------------
date
Permit No. -- l-/—G —----------------- i. Issued---------------------- -----------
----------=---------------------------------
�b dahe
,l ..
BOARD OF HEALTH
TOWN OF BARNSTABLE ,`
Certificate ®f (Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed (, ),, Altered..( ), or,Repaired ( )
i by
Installer
at--------- &----------------------------------------------------------
has been installed in accordaVce with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described.in the application for Well Construction Permit N . ------------ ;;------__Dated------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE ---- — —-- — - - ---- — -- Inspector==- - --------------------------------=_=-------------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
melt (Construct ion permit
No. �_ � —
------ - Fee------------------
Permission is hereby granted------> =' i=,� -- ------------------------------------
to Construct'(O, Alter ( ), or Repairg( )Van Individual ell at:No. ----4-----------1 ;� -— x�`- --------- f------ - - Q'y— Street — —
as shown on the application for a Well Construction Permit '
No.- -1 --- ---- --- —-------------- Dated----- --------------------;.;;-=---------------
----------------- ------------
G' Board,of Health
DATE--— f --I � -- ----- -
r�
S
w 10`0 � ,;e !� 6 ✓' z ( 7. �° � LEAC�G�FACILITY
y `► s ,.
i CAPACITY:4'�
SIDEWALL: S
;BOTTOM• l(
tiri ? :,� P h TOTAL:
a +
� .,: fr`•'` i... .« .i, ' ��� � �� .`s ;-�� �'L. �--- is ).
1 ch-
S" '. ..gr .--++`' -x?`.:ay '.R k ..rt+w. �,t..�wv a,,:" "^ r.--r-.:o...+.-.c...••..,.#--.i.>a7u..�.. 'f '[
R R F91 ., TO `BE LAID 2"LAYER OF3/8"PEASTONEAk h
'•LEVEt.FOR 2''`OUT.OF OVER 3/4 -1 1127 WASHED
# tl DISTROWTION BOX .STONE ALL AROUND
s°$�P( i,� i..r,.
r,r f BALLt-1Y?$E t"blA. •1�i 1i�"` T6
a ` wUSB Ai.1, Ai�Pi,ICABLE r Jk OLi. l�l��:. ,(�. M./ a fo" 'A-1 Cf
—A—
x�,r
THIS'SM M is NOT DE51dN D,FOR
THE
U$8 OF A OARBAGS'DI'OSAL
N
It'
ow o.yf
SEW` SYSTEM PROFILE
10,
Ilk 4,
R y;�
f _ � � F'i .T a v g i}}# #.ny,. +,..+++•-r..,+ _- _. _.. a n.:.3
�,�H:nF&gss GENERAL P
DANIEL e, 9�y 1. CONTRACTOR TO BE RESPn
SITE-►SEWAGE pL y �" ` 10 avuN G LOCATION OF ALL UTILTT
No.32686C UNDERGROUND PRIOR TO
FOR OR EXCAVATION.
4 , ' ar'IK.
r
ml N P 2. INSTALLATION OF SEPTIC*
1
COMPLIANCE WITH 316 CM
PREPARED-FOR ,
3
ow
3. THIS PLAN IS NOT TO BE U:
13
{ 1! LINE DETERMINATION.
' WELLER&ASSOCIATES
BOX 1,19 YARMOUTKPORT MA.02675
(508)'3-61-8131 APPROVED BY:
^ 'i`t.".''vrt^*^"�;,rFy .y,R^+,�' _,.6� S'!9 :•T,.� ''}?r4s'`,�„ %tx „�Y+ i ..s,r;';h•t:�
P�F'7-: -TEST'BY,:!.WELLER`& ASSOC.
VMN6&),�I�i�
44-
PERC RATE:.4. t4
Wo
rz
.4i
103,,o
f
tr-7
'e,
SAr.F is ,_,9 •,� i i v1 , 4i. ifi 6'y Y 'b �'7 _. ..+ b . �;
t'b
jzc;!P T1,0 L�—
.. ........
7-7-1
J,
"f,i fie'. DESIGN DATA
�X
DAILY MOW:M*io k I)*4r0,
A SEPTIC TANK:5tbAr,�.'XZ6*%=4
t
1JSVf
brW* G FACILITY
TjSE (3,4 rwtio
f
LA"
CAPACITY:
'SIDEWALL-. ac> K t.)c -7�
,BOTTOM: k0K
TOTAL:
4 'C,
4.
V!
MR TO 'BB, LAID 2LAYKR OF 318-PRASTONE
tdkll''OUT OF �F"
OVER 3/4".1 1/2" WASHED
bMftftUftONBOX i STONE ALL AROUND
j
To
134" e
4
ALL PEPE'td$8 0 DLL.i CHOPVC
LICABLI MANIMM . -15c&
T.A
A'
APP N "'L. cr
44 'OF immsih
GRAT)IR'
I� �. •
to
cO Certified Mail Fee
0, $
r Extra Services&Fees(check box eddlee asap pmte)g,
❑Retum Receipt(hardcopy)
M ❑Retum Receipt(electronic $ 2� Postmen
O []Certified Mail Restricts joelivery $-t. t7� Here
C3 ❑Adult Signature Required' $ % _•`
[]Adult Signature Restrlcted DeliveW$ .9 .
f ------ -- -
� i C `� �Uy � ��' IV J
FSHEEH/aN, f IL LYONS
� �'� 35 BURSLEY PATH`
I o ; WE'ST4BARNSTABLE�MA 02668
Certified Mail service provides the following benefits:
■A receipt(this portion/r(the Certified Mail label). for an electronic return receipt,see a retail
•A unique identifier f.r your mailpiece. associate for assistance.To receive a duplicate
■Electronic verification of delivery or attempted return receipt for no additional fee,present this L,
delivery. USPS®-postmarked Certified Mail receipt to the
■A record of deliveryg p retail associate.
(including the recipient's
signature)that is retained by the Postal.Service- Restricted delivery service,which provides j
for a specified period. delivery to the addressee specified by name,or
to the addressee's authorized agent
Important Reminders. Adult signature service,which requires the t
■You may purchase Certified Mail service with signee to be at least 21 years of age(not ,
First-Class Mail®,First-Class Package Service®, available at retail). r
or Priority Mail®service. Adult signature restricted delivery service,which
■Certified Mail service is notavailable for requires the signee to be at least 21 years of age
International mail. and provides delivery to the addressee specified h
■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent.,
with Certified Mail service.However,the purchase (not available at retail).
of Certified Mail service does not change the '
g ■To ensure that your Certified Mail receipt Is
insurance coverage automatically included with accepted as legal proof of mailing,it should bear a
certain Priority Mail items. USPS postmark.If you would like a postmark an
■For an additional fee,and with a proper this Certified Mail receipt,please present your
endorsement on the mailpiece,you may request Certified Mail Item at a Post Office'for
the following services: postmarking.If you don't need a postmark on this
-Return receipt service,which provides a record Certified Mail receipt,detach the barooded portion .
of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply .-
You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. j
electronic version.For a hardcopy return receipt,
complete PS Form 3811,Domestic Retum
Receipt*attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records.
Ps Forth 3800,Apra 2ois(Reverse)PSN 7s3o-o2-ooc. 7
rSENDiER:'C`O'MPLETETH'IS SECTION ''COMPLETE THIS SECTION ON DELIVERY�,�
■ Complete items 1,2,and 3. Ireverse
Signature
■ Print your name and address on thX ❑Agent
so that we can return the card to y _ ❑Addressee
■ Attach this card to the back of theB• Recei d by(Prf ed N me) -C. Date of Delivery
or on the front if space permits. -
1_n,*I^-I.-AH,l—�QM rn• Is Helivery address different from item 17 ❑Yes
idelivery address below: ❑No
SHEEHAN, NELLY LYONS
35 BURSLEY PATH -
WEST BARNSTABLE, MA 02668
-- -- - — ❑Priority Mail Express@
❑Adult Signature ❑Registered MailTM
II I IIII'I IIII I'I I IIIIIi�Illllil II I I I I(� III)III�� 0�Adult
Signature
a®Restricted Delivery ❑Regi:tvstered red Mail Restricted
C
9590 9402 5357 9189 1903 71 n Certified Mail Restricted Delivery Merchandise
mReceipt
for
Collect on Delivery
2. Article_Number[Trancfe,f- -- "?-livery Restricted Delivery Signature ConfirmationTM'
�— t ❑Signature Confirmation
Q'15 17 3 0 0 p p 1 49 8;8 9 8 5 o s .- 'I Restricted Delivery Restricted Delivery
I ro' 5 00) E
PS Form 3811,July 2015 PSN 7530-02-000-9053 'Domestic Return Receipt
USP�L.� 4ioTia ..6:3� cc
First-Class Mail
Postage&Fees Paid
USPS
Permit No.G-10
9590 9402 5357 9189 1903 71 j
I
United States •Sender:Please print your name,address,and ZIP+4®in this box*
Postal Service
I
TOWN OF BARNSTABLE
PUBLIC HEALTH DIVISION
200 MAIN STREET
HYANNIS, MA 02601-
I
I
I }iiili�=iiJ�;i; litiiiiitllFili!l;;����li;;lii3j;; tfiiij►,i�:i.ii
i
1
Town of Barnstable
Inspectional Services Department
BARNSTABM
MAn
0 19. ,m� Public Health Division
rfO" s 200 Main Street, Hyannis MA 02601
Office: 508-862-4644
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL#7015 1730 0001 4988 0985
October 23, 2019
SHEEHAN,NELLY LYONS
35 BURSLEY PATH
WEST BARNSTABLE, MA 02668
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 35 Bursley Path, West Barnstable, MA was inspected on
10/01/2019 by Brett Hickey, certified Title V Septic Inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Fails" under the guidelines
of 1995 TITLE V (310 CMR 15.00) due to the following:
• Leaching facility with standing liquid level at or above the invert pipe (per
Town Code 360—20h).
You are ordered to repair or replace the septic system within two (2)years from the date
you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER OF THE BOARD OF HEALTH
Thomas McKean, R.S., CHO
Agent of the,Board of Health
Q:\SEPTIC\Title.V Inspection Report Letters.Mailing\Failed or Needs Further Evaluation Letters\35 Bursley Path West
Bamstable.doc
Town of Barnstable
IIARNSfAHLE,
MASS
039. A Inspectional Services Department
Arfb MA'S
Public Health Division
200 Main Street, Hyannis MA 02601
Office: 508-862-4644
FAX: 508-790-6304 Thomas A.McKean,CHO
Feb 6, 2007
Rev. 4/26/19
DEADLINES TO REPAIR FAILED SYSTEMS
(Town Code §360-44 and Title V: 310 CMR 15.000)
An"x" marked in the ❑ is the failure criteria and associated repair deadline
60 DAY DEADLINE CRITERIA
❑ Discharge or ponding of effluent to the surface of the ground
❑ Pumping more than 4 times during the last year not due to clogged or obstructed
pipe.
❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool
❑ Structurally unsound septic tank or SAS
ONE (1) YEAR DEADLINE CRITERIA
❑ Static liquid level in the distribution box above outlet invert due to an overloaded or
clogged SAS or cesspool
❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation
❑ Any portion of the cesspool within a Zone 1 to a public well
❑ Any portion of a cesspool within 50 feet of a private water supply well with no
acceptable water quality analysis. (This system passes if the water analysis
indicates the well is free from pollution).
TWO (2) YEAR DEADLINE CRITERIA
❑ Single Cesspool
❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation
of a driveway due to H-10 components, etc)
aching facility with standing liquid level at or above the invert pipe (per Town
Code §360-20 h)
OTHER
Repair deadline:
O:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc
., US 9- ObCo
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M'
35 Bursley Path '
Property Address + a
Nelly Lyons
Owner Owner's Name / f
information is West Barnstable p/ Ma 02668 10-1-19 r
required for every
page. City/Town State Zip Code Date of Inspection "
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. Inspector Information
on the computer, Brett Hickey
use only the tab
key to move your Name of Inspector
cursor-do not B&B Excavation
use the return Company Name
key. '
374 Route 130
y Company Address
Sandwich Ma 02563
City/Town State Zip Code
rrcr (508)477-0653 S113747
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined
that the system:
1. ❑ Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑■ Fails
Brett Hickey
10-1-19
pate:20t9.1°.OJ tJ19:5B Oa'O°
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: This report only describes conditions at the time of inspection and under the
conditions of use at that time.This inspection does not address how the system will perform
in the future under the same or different conditions of use.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
35 Bursley Path
Property Address
Nelly Lyons
Owner Owner's Name
information is West Barnstable Ma 02668 10-1-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
r
1) System Passes:
,
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
2) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND(Explain below):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18
c Commonwealth of Massachusetts
�v Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
............. / 35 Bursley Path
Property Address
Nelly Lyons
Owner Owner's Name
information is West Barnstable Ma 02668 10-1-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
3) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
a. System will pass unless Board of Health determines,in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
r;
35 Bursley Path
Property Address
Nelly Lyons
Owner Owner's Name
information is West Barnstable Ma 02668 10-1-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS.is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
"*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
lif r co o m bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
p 9 9 q
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
c. Other:
4) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
El ❑ Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ a Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
35 Bursley Path
V
Property Address
Nelly Lyons
Owner Owner's Name
information is West Barnstable Ma 02668 10-1-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
❑ a Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ a Liquid depth in cesspool is Jess than 6"below invert or available volume is less
than '/z day flow
❑ El Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ El Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ 0 Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ❑ Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ El Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ 0 Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain'of custody must be attached to this form.]
❑ 0 The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
0 ❑ The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303,therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
5) Large Systems: To be considered a large system the system must serve a facility with a
- design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section CA.
Yes No
` ❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA) or a mapped Zone II of a public water supply well
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18
9 P Y 9
c Commonwealth of Massachusetts v
�a Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
35 Bursley Path
v�
Property Address
Nelly Lyons
Owner Owner's Name
information is West Barnstable Ma 02668 10-1-19
required for every
City/Town/Town State Zip Code Date of Inspection
page. Y P P
C. Inspection Summary (cont.)
If you have answered"yes"to any question in Section C.5 the system is considered a significant
threat, or answered "yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes" or"no" for each of the following for all inspections:
Yes ` " No
El ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ El Were any of the system components pumped out in the previous two weeks?
El ❑ Has the system received normal flows in the previous two week period?
❑ ❑ Have large volumes of water been introduced to the system recently or as part of
this inspection?
0 ❑ Were as built plans of the system obtained and examined?(If they were not
available note as N/A)
❑ 0 Was the facility or dwelling inspected for signs of sewage back up?
El ❑ Was the site inspected for signs of break out?
El ❑ Were all system components, excluding the SAS, located on site?
El ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ 0 Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS) on the site has
been determined based on:
El ❑ Existing information. For example, a plan at the Board of Health.
❑ 0 Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
t5insp.doc-rev.7/26/2018, Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
cam, Commonwealth of Massachusetts
,lp Title 5 Official Inspection Form
?= Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
35 Bursley Path
Property Address
Nelly Lyons '
Owner Owner's Name
information is required for every west Barnstable Ma 02668 10-1-19
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
No design plan 3
Number of bedrooms(design): Number of bedrooms(actual):
NA
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):
Description:
Plan was unable to be located of Board of Health
1
Number of current residents:
Does residence have a garbage grinder? ❑ Yes G] No
Does residence have a water treatment unit? ❑ Yes rol No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes No
information in this report.)
Laundry system inspected? ❑ Yes 0 No
Seasonal use? ❑ Yes No
Water meter readings, if available (last 2 years usage (gpd)): See below
Detail:
***WELL WATER***
Sump pump? ❑ Yes ❑■ No
y current
Last date of occupancy: Date
t5insp.doc•rev.7/26/2018 " Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 -
Commonwealth of Massachusetts
�m Title 5 Official Inspection Form
±' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
35 Bursley Path
L
Property Address
Nelly Lyons
Owner Owner's Name
information is west Barnstable Ma 02668 10-1-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
NA
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft.; etc.):
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
,Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information: Owner- date of last pump: July 2019
Was system pumped as part of the inspection? ❑ Yes M .No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
�= P' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
35 Bursley Path
V
Property Address
Nelly Lyons
Owner Owner's Name
information is West Barnstable Ma 02668 10-1-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
El Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known) and source of information:
unknown
Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No
5. Building Sewer(locate on site plan):
2'6"
Depth below grade: feet
Material of construction:
❑ cast iron ❑Q 40 PVC ❑ other(explain):
` >100' from well to SAS
® Distance from private water supply well or suction line: feet
' Comments(on condition of joints, venting, evidence of leakage, etc.):
Y
t5insp.doc-rev.7/26/2018, Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
35 Bursley Path
L=
Property Address
Nelly Lyons
Owner Owner's Name
information is West Barnstable Ma 02668 10-1-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
1'611
Depth below grade: feet
Material of construction:.
❑■ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by.a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
1
Dimensions: 500gallons
5"
Sludge depth:
31"
Distance from top of sludge to bottom of outlet tee or baffle
- 2"
Scum thickness
6"
Distance from top of scum to top of outlet tee or baffle
14"
Distance from bottom of scum to bottom of outlet tee or baffle
measured
How were dimensions determined?
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
The tank was in working order at the time of inspection. The tank is not in need of pumping
at this time but should be pumped every two years for maintenance.
t5insp.doc•rev.7/26/2018 r Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
.......... 35 Bursley Path
Property Address
Nelly Lyons
Owner Owner's Name
information is West Barnstable Ma 02668 10-1-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap(locate on site plan):
NA
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping:
Date
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
NA
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow:
gallons per day
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18
c Commonwealth of Massachusetts
�d Title 5 Official Inspection Form
?= 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
35 Bursley Path
Property Address
Nelly Lyons
Owner Owners Name
information is West Barnstable Ma 02668 10-1-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box(if present must be opened) (locate on site plan):
0'r
Depth of liquid level above outlet invert
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
The d-box was in poor condition at the time of inspection with heavy carry over present.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
Commonwealth of Massachusetts
�n Title 5 Official Inspection . Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
35 Bursley Path
V
Property Address
Nelly Lyons
Owner Owner's Name
information is West Barnstable Ma 02668 10-1-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.) ,
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ 'No*
Alarms in working order: ❑ Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
NA
* If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on site plan; excavation not required):
If SAS not located, explain why:
Type.
❑ leaching pits number:
(3)500 gallon chambers
El leaching chambers number:
M ❑ leaching galleries number:
❑ leaching trenches number, length:
leaching fields number, dimensions:
❑ . ' overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
f t5insp.doc-rev.7/26/2018 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
35 Bursley Path
V
Property Address
Nelly Lyons
Owner Owner's Name
information is required for every west Barnstable Ma 02668 10-1-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
The SAS was in hydraulic failure at the time of inspection. Leaching chambers were
full over inlet invert when viewed.
12. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan):
NA
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
35 Bursley Path
V�
Property Address
Nelly Lyons
Owner Owner's Name
information is West Barnstable Ma 02668 10-1-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
13. Privy(locate on site plan):
Materials of construction: NA
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 16
c Commonwealth of Massachusetts
�m Title 5 Official Inspection Form -
I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
35 Bursley Path
Property Address
Nelly Lyons
Owner Owner's Name
information is West Barnstable Ma 02668 10-1-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below:
❑■ hand-sketch in the area below
❑ drawing attached separately
,A B
Al-20' 131-60'
0 A2.34' B2.62'
1
0
2
t5insp.doc-rev.7/26/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
r;
35 Bursley Path
�t f�
Property Address
Nelly Lyons
Owner Owner's Name
information is west Barnstable Ma 02668 10-1-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
FM Check Slope
X Surface water
❑■ Check cellar
■❑ Shallow wells
Estimated depth to high ground water: No GW @ 12'feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked,`date of design plan reviewed: Date
Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
A topo map was used to determine high groundwater. Ground water is greater than
12'.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
I
c Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
i� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
35 Bursley Path
v
Property Address
Nelly Lyons
Owner Owner's Name
information is West Barnstable Ma 02668 10-1-19
required for every
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
■❑ A. Inspector Information: Complete all fields in this section.
■❑ B. Certification: Signed g & Dated and 1, 2, 3, or 4 checked
❑■ C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria)and 6(Checklist)completed
❑■ D. System Information:
For 8: Tight/Holding Tank—Pumping contract attached _
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18
I
J 00I
{ q
l �
PRO,F05E0
DECK
�., . (Af;
I No. 55
r 2 S7Y.
D. FRIVI.
t �
I / _
' f -
I �
f F
LOB' I
35,044:{.5F
I HIMMY CST•€FY THAT, TO T€1E M5T or MY KNOUVLIrDM, AND iN MY FR01-E550NAL OPINION
PIE LOCATION OF THE PROPMEED SWIMMING, AS SHOWN HEREON. CONFORMS WITH THE
HOKIZQAITAL 5ET-BACK REQUIVJ=-MEN7r5 OF THE TOO tv OF BARN5TADL1=ZONING BY-LAW.
1
RICHARD J. HOOD, PL5 CATE
- i
PLAN TO ACCOMPANY JOB No.: 043CS
POOL PERMIT APPUCATION DATE. 02DEC04
IN BARN5TABLE, MA55AC�!U5ET75 sc�€.E. I' - 40'
PREPARED FOR
'jam TEST HOLE LOG
DAT .
^v T� o� /V E: 7,19167
76 I C TEST BY:WELLER& ASSOC.
I WITNESS: f-V lEAdZSZy - r-e6c>4-
Sy PERC RATE: « NoJ I►1
105,0
SAKNO
too
O�
�—
Mt:n►L�►�
Out / lzc� WO
/ dZ_
i�c K DESIGN DATA 330
\\ Jag DAILY FLOW:�3` ipo.&hlto ewot
J SEPTIC TANK:3p-lifV x bo%=4040 G
f 1 / USE:16M Gat.. ?V0.cA,-lS_55p `-fN,-r-
LEAC G FACILITY: xr
USE:(3)4kt3a LoLMI s aC�8t i. •tjz,
CAPACITY. (b
* v 02 SIDEWALL: So x2x .7+: 11 a .4—
BOTTOM:
TOTAL: 34o.4- !?O
t,ealth Department
Town of Barnstable
P o-Box 534
-;vannis..Massachusetts 02601
t z:,Y(5J3)775 3344
( . 1�.^•^�71^ F265
PIPE TO BE LAID 2"LAYER OF 3/8"PEASTONE
LEVEL FOR 2' OUT OF OVER 3/4"-1 1/2" WASHED
DISTRIBUTION BOX STONE ALL AROUND
TOP OF FOUND.
® Ib7.00 ` -rcf v .. 101,50
10" 14" C
a � Ia2.ow tol.(-7
ALL ': 'B TO BE 4"DIA.SCH 40 PVC
RAISE ALL APPLICABLE MANHOLE (t�'-fief M �"•�1" �W
COVERS TO WITHIN 6" OF FINISH
GRADE
THIS SYSTEM 1S NOT DESIGNED FOR
THE USE OF A GARBAGE DISPOSAL
SEWAGE SYSTEM PROFILE
SCALE: 1"=10'
Ll1+trF&9r GENERAL NOTES
DANIEL E. q�d 1. CONTRACTOR TO BE RESPONSIBLE FOR THE
SITE-SEWAGE PLAN o °��" �� LOCATION OF ALL UTILITIES,ABOVE AND
No.anesc ti UNDER GROUND,PRIOR TO ANY CONSTRUCTION
LO
$4� 4,�OR r,,lA o��� �� � OR EXCAVATION.
f��i N� O
p� '� 41S �e � � L r �" Z, INSTALLATION OF COMPLIANCE WITH SEPTIC
0 ICMR 15.00:TITLE V.
PREPARED FOR �Z-`1-g-tTS' '
3. THIS PLAN IS NOT TO BE USED FOR PROPERTY
LINE DETERMINATION. ,
SCALE: fly, �-o DATE:
WELLER &.ASSOCIATES
P. O. BOX 119 YARMOUTHPORT, MA. 02675
(508);362-8131 APPROVED BY:
4
COVERS TO BE WATERTIGHT AND SEPTIC SYSTEM PROFILE Flahe Environmental Services
TOP OF FOUNDATION BROUGHT TO WITHIN 6"OF FINAL GRADE
EL. 58.0' EL. 56.0' (not to scale) INSP. PORT W I 3" OF GRADE
CLEAN SAND P.D. Box 331
2"of$"to§" DOUBLE WASHED EL. 56.0' Harwich, MA 02645
4"CAST IRON or EQUIVALENT PEASTOWOR GEOTE MLE —�` 774.994.1166
MIN. PITCH 1/4"PER FOOT FILTER FABRIC
4'SCHMULE 40 PVC PIPE 4'SCHEDULE 40 PVC PIPE
VENT IF REQUIRED
FLOW LINE fAle12'tO bB AaVBl1
' 1.8% EL 54.01
EXIST. " _i jim® • ®® o°000°°SE
iNll� 14'I:.'�'• GAS BAFFLE EL
0o000000 o oo oo 00°000000°0000°0ooec
000100 0000 000000 053. 53.03' 0 .000000 000cc
2.01
000O oO° �L 53.2' 0° 0EL 53.0 °o° ° 0000o0o0ccoD(H-Z D-SO DO0000
O°o°o °o° 1?020!0205 EL S1.0'
•f
' • ` �, • •• •• 6"CRUSHED STONE OR
SOIL ABSORPTION SYSTEM
MECHANICALLY COMPACTED (2) 500 GALLON H-20 CHAMBERS 7.0'
(DATUM: ASSUMED) I500 GALLON SEPTIC TANK ,
. / WITH 4 STONE AROUND IN A
�° No� 4" to 1 " DOUBLE WASHED STONE 12.83'X 25'X 2'CONFIGURATION
BV(tSt- Pam— � BOTTOM OF TEST HOLE EL. 44.0' EL.
USGS ADJUSTMENT: N/A LOCATIONA14P
\ \ GROUNDWATER ELEV: N/A
eIt Path � `�
\ LOCUS
LOT I ` \
35,044 SFf \
MAP 89 LOT 6
DRIVEWAY \ NT5
GARAGE DAVID yG
EXISTING // 54 4
T 3 BR " FLA -4
DVELLING
v
IZ lS0' WELL SHE � j �# $TES'
42.8— _ _.._ — ' �iITAIRO
d► '� V
EXIST.S.T. O EXIST.SAS 7/
BENCJiMARK: (IPPRDX)
TOP OF FNDN
EL.58.0' 3� ti-' DATE.2n1/2M REVISED:
c?0o- o 23. •
O
? A EXIST.
10.2 T t POOL.
LEGEND SITE AND SEWAGE PLAN
56 54'; FOR
6 GAS LINE B& B EXCAVATION, INC.1
-w W W W- WATER LINE NELLY LYONS SHEEHAN
E E—E—E E EXIST. ELECTRIC 54 35 BURSLEY PATH
99 EXIST. CONTOURS
————— 99 PROP, CONTOURS SCALE : 1 401 WEST BARNSTABLE, MA
NAE—U fs UAC— UNDERGROUND UTIL.
REF.•W 8 A PLANDAM 121511995 S PB 418 PO SS PAGE!OF2
..........._.. ........................... .............................. .................. ............................................_................_.........................___.._.........._..._._.................._................__........_..................._........................_....................................._......_.._.......................... . .... ........................
GENERAL NOTES DESIGN CALCULATIONS SYSTEM DETAIL Flaherty Environmental Services
1. ALL PRECAST COMPONENTS TO BE H-10 P. O. Box 331
RATED UNLESS OTHERWISE SPECIFIED. Harwich, MA 02645
DISTRIBUTION BOX AND ANY NUMBER OFACTUAL BEDROOMS 3 774.994.1166
COMPONENTS WITH ANY ANTICIPATED
VEHICULAR TRAFFIC TO BE H-20 RATED. GARBAGE DISPOSAL UNIT NO
2. THE DESIGN OF THIS SYSTEM DOES NOT
ALLOW FOR THE USE OFA GARBAGE TOTAL ES TIMA TED FL 0 W
GRINDER. (110 GAL/BR/DAYX 3 BR) 330 GALADAY
3. MUNICIPAL WATER IS NOT AVAILABLE. REQUIRED SEPTIC TANK CAPACITY 660 GAL.
4. ALL CONSTRUCTION TO CONFORM WITH 2 S'
} 310 CMR 15.000 AND ALL OTHER SIZE OF SEPTIC TANK 1500 GAL.(EXISTING)
APPLICABLE LOCAL, STATE AND FEDERAL
CODES AND REGULATIONS. SOIL CLASSIFICATION 1
5. INSTALLER/CONTRACTOR TO REVIEW&
VERIFY ALL ELEVATIONS AND DETAILS DESIGN PERCOLATION RATE <2 MINANCH
AND REPORT ANY DISCREPANCIES TO L./DAY/FT'
DESIGNER PRIOR TO CONSTRUCTION OR
EFFLUENT LOAD/NG RATE 0 74 GA O O 12.8 3
ASSUME ALL RESPONSIBILITYY, LEACHING AREA ..
6. INSTALLER/CONTRACTOR IS (2)x(25.0'+ 12.83X2) =151 SF
RESPONSIBLE FOR MAINTAINING SAFE 25.0'x 12.83' =320 SF
WORK AREA, VERIFYING ALL UTILITIES 471 SFx a74 =348 GPD
AND NOTIFYING "DIG SAFE"
(1-888-344-7233) 72 HOURS PRIOR TO USE(2)500 GALLON H-20 CHAMBERS WITH 4'STONE
CONSTRUCTION. INA 12.83'X25'CONFIGUR4TIONASD14GR4MMED
7. ANY CHANGES TO OR DEVIATIONS FROM
THIS PLAN MUST BE APPROVED IN RESERVE LEACHING CAPACITY NIA
WRITING BY FLAHERTY ENVIRONMENTAL
SERVICES AND LOCAL BOARD OF
HEALTH.
8. FINISH COVER OVER COMPONENTS IS
NOT TO EXCEED 3'PER 310 CMR 15.000 (NTS)
UNLESS SHOWN PER PLAN.
9. ALL ABANDONED SEPTIC SYSTEM
COMPONENTS TO BE PUMPED DRYAND
FILLED WITH CLEAN SAND OR REMOVED SOIL EVAL UA TION
AND REPLACED WITH CLEAN SAND. TESTHOLEM nwr#20-19 TESTHOLEW MW20-19
IO.ALL COMPONENTS TO BE PROVIDED Evaluator. David D.ftherly Jr.,RS,REHS Evaluator. David D.Fla"Jr.,RS,REHS OF
WITH WATERTIGHT ACCESS PORTS SE#2755 SE#2755 o� y
WITHIN 6"OF FINISH GRADE. BOH W/Mees. David Stanton,RS BOH WM o David 8tw*v RS
'r Date: Febmwy 10,2020 Date: Febnrmy 10,2020
II.ALL SEPTIC TANKS, DISTRIBUTION �k
BOXES AND PIPING TO BE INSTALLED rH-1 ELEV 56.01 n1-2 ELEV 5s a
T. f'I�
WATERTIGH �GI
12.NO KNOWN WETLANDS OR WELLS o•-r FILL o•-r FILL a sTE
WITHIN 150 FEET OF PROPOSED N►TAtt`�` t ?jl1
LEACHING. r-15• A cs 10rRsr2 r-15• A LS 10YR32 7j
13.THIS IS NOT A CERTIFIED PLOT PLAN
AND UNDER NO CIRCUMSTANCES IS THIS 15•-2a• B LS 101'R516 15•-280 6 LS 10YRW
PLAN TO BE USED FOR ZONING OR •l ow*Mat on November 12,2002,1 have passed
BUILDING PURPOSES. 50•�Pew Me examirm0an approved by Me Department of SITE AND SEWAGE PLAN
14.LOT IS SHOWN AS ASSESSOR'S MAP 89 E""Ir"""1e1tal Pro "and bW ft above
FOR
w1M has been Perlbmred by me consistnt e Me
LO
T 6. 2e•-144• C MS 2.5Yt�Vl3 28•-120• C Ms 2.5YQ/8 requlied t�a/Milg, ' B & B EXCAVATION INC./
15.LOCUS PROPERTY IS NOT LOCATED /n 310 CMR 15.018(2).• NEL L Y L YONS SHEEHAN
WITHIN AN TE AQUIFER PRO CTION t
DISTRICT(ZONE 11). 35 BURSLEY PATH
G.W.ELEV.wA G.W.ELEV.wA WEST BARNSTABLE, MA
BOTTOM TH-1 ELEV. 44.0' BOTTOM T1-2 ELEV 48.0'
PAGE2 OF2 DATE.•211112020
.................................. .................................... ................. ....... ......................................................... .............. .................................................................. . . ..............................